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Positive predictive values in clinical screening for developmental dysplasia of the hip
Hans-Christen Husum1, Arash Ghaffari1, Laura Amalie Rytoft1
1Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
Insights
The positive predictive value of clinical hip examinations for Developmental Dysplasia of the Hip (DDH) screening in Denmark is low. This indicates a need to refine referral criteria for the DDH screening program.
Area of Science:
- Orthopedics
- Pediatrics
- Radiology
Background:
- Developmental Dysplasia of the Hip (DDH) is a condition affecting infants.
- Early detection through screening programs is crucial for effective treatment.
- Clinical hip examinations are a key component of DDH screening protocols.
Purpose of the Study:
- To determine the positive predictive value (PPV) of clinical hip examinations in the Danish DDH screening program.
- To evaluate the PPV across different referrer groups (GPs, midwives, pediatricians) and diagnostic criteria.
Main Methods:
- Retrospective analysis of 290 children referred with positive clinical hip examinations.
- Calculation of PPV using three definitions of true positive DDH diagnosis.
- Comparison of PPV between general referrers and pediatric orthopedic surgeons.
Main Results:
- Overall PPV for clinical hip examinations by referrers ranged from 1.8% to 5.4%.
- PPV was higher when defined by ultrasound classification (≥Graf IIc) by orthopedic surgeons (33.3%).
- Low PPV suggests potential over-referral in the screening program.
Conclusions:
- Clinical hip examinations by referrers in the Danish DDH screening program have a low positive predictive value.
- This highlights a need for improved accuracy in clinical assessments for DDH screening.
- Refining referral criteria may enhance the efficiency of the DDH screening program.
Aim:
To establish the positive predictive value (PPV) of clinical hip examinations performed by referrers in the Danish screening programme for Developmental Dysplasia of the Hip (DDH) utilising three definitions of true positive DDH diagnosis.
Methods:
We retrospectively identified 290 children (169 female) referred during a 4-year period to the orthopaedic outpatient clinic at our institution with a positive clinical hip examination. Positive predictive value was calculated for clinical hip examinations across three definitions of a true positive clinical hip examination for all referrers and subgroups consisting of general practitioners, midwives and paediatricians. The PPV for clinical hip examinations was calculated for paediatric orthopaedic surgeons using one of the three definitions.
Results:
Positive predictive value of clinical hip examinations for all referrers were 5.4%, 3.6% and 1.8% with the definition of a true positive DDH diagnosis defined as clinical instability found by orthopaedic surgeon, ultrasound classification ≥Graf IIc or both definitions combined, respectively. Positive predictive value of clinical hip examinations performed by orthopaedic surgeons was 33.3% with a true positive clinical examination defined as an ultrasound classification ≥Graf IIc.
Conclusion:
We conclude that the positive predictive value of clinical hip examinations made by referrers in the Danish screening programme for DDH is low.
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